Mini Quiz: Deep Brain Stimulation for Depression

Which of the following is true regarding deep brain stimulation (DBS) for treatment-resistant depression?

Choices

A. Response rates are higher than those for electroconvulsive therapy (ECT)

B. Response is sustained, with over 50% of patients continuing to respond at 8 years post-treatment

C. It is an FDA-approved treatment for patients who have not responded to at least 3 serotonergic medications

D. The chance of significant psychological side effects is minimal

A. Response rates are higher than those for electroconvulsive therapy (ECT)

24% (34 votes)

B. Response is sustained, with over 50% of patients continuing to respond at 8 years post-treatment

24% (35 votes)

C. It is an FDA-approved treatment for patients who have not responded to at least 3 serotonergic medications

24% (35 votes)

D. The chance of significant psychological side effects is minimal

27% (39 votes)

Total votes: 143

The correct answer is B.

Discussion

DBS involves MRI-assisted electrode implantation directly into brain regions associated with mood. The procedure takes 3 to 6 hours and is done under a combination of local and general anesthesia. Multiple brain targets have been tested in clinical trials, all with similar effects, which suggests that they may all be nodes in a common “mood regulation” network.1 DBS has only been tested in patients who no longer respond to any other therapy.

Initially, DBS patients report “disappearance of the void,” reduced anxiety, increased connectedness, and euphoria, subjective changes that usually fade within minutes to hours. Continued stimulation over weeks to months leads to more gradual improvement. In early open label studies, response rates were 40% to 66% in severely treatment-refractory cases.2,3 When it is effective, the benefits appear to last—a recent study reported over 50% response rate at 8 years post-DBS.4

Risks include intracranial bleeding, stroke, seizure, and infection, but all are very rare (less than 1%). Adverse psychological effects are more common—up to 50% of patients may experience worsened mood, anxiety, or hypomania while their clinicians search for optimal stimulation settings. Furthermore, patients often see DBS as a last resort.